Dual innervation of free gracilis muscle for facial reanimation: What we know so far |
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| Affiliation: | 1. Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, US;2. Department of Neurology, Mayo Clinic, Rochester, MN, US;1. Department of Plastic Surgery, University of Pittsburgh Medical Center and Children''s Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania;2. Division of Pediatric Plastic Surgery, Advocate Healthcare Hospital. Park Ridge, Illinois;3. Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences. Chicago, Illinois;4. Department of Emergency Medicine, University of Pittsburgh Medical Center. Pittsburgh, Pennsylvania;5. Division of Plastic Surgery, Section of Pediatric Plastic Surgery. Albany Medical Center and Bernard and Millie Duker Children''s Hospital at Albany Medical Center. Albany, New York;1. Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada;2. Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada;3. Division of General Surgery, University of Ottawa, Ottawa, Ontario, Canada;4. Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada;1. St. Andrew''s Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom;2. Department of Plastic and Reconstructive Surgery, University Hospital Brussels (UZ Brussel), Belgium;1. Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands;2. Department of Plastic Surgery, Erasmus Medical Center, ''s-Gravendijkwal 230, 3015 Rotterdam, CE, the Netherlands;3. Department of Radiology, Ziekenhuisgroep Twente in Almelo and Hengelo/Medisch Spectrum Twente, the Netherlands;4. Department of General Surgery, Ziekenhuisgroep Twente Almelo and Hengelo, the Netherlands;1. Ca’ Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy;2. Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy;1. School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom;2. St George''s, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom |
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| Abstract: | BackgroundIn the last decade, some institutions have begun combining the CFNG and masseteric nerve to provide dual innervation to the gracilis muscle for dynamic facial reanimation in facial paralysis patients. We reviewed the various ways that these two nerves have been coapted to provide dual innervation, and summarized the functional outcome for these methods.MethodsA search of the Ovid EMBASE, MEDLINE, Cochrane, and Scopus databases was performed from 1946 to May 2019 for dual innervation of gracilis muscle using CFNG plus masseteric nerve for facial reanimation.ResultsA total of 184 articles were identified in the initial search, of which seven met our inclusion criteria. Three additional abstracts with 43 patients were identified but the level of details was not sufficient to include the results in the analysis. A total of 57 patients were reviewed (mean age of 42.1 years (6–79 years)). The majority of dual innervation procedures were performed using the ipsilateral masseteric nerve sutured end-to-end to the obturator nerve, and an additional CFNG connected end-to-side to the obturator nerve. In the 26 patients with Terzis scores available, there were no differences between masseteric nerve coapted end-to-end and CFNG as end-to-side to the obturator, or the reverse coaptation. All but two patients achieved function of the gracilis activated by the masseteric nerve within 2–5 months.ConclusionsThis review shows that dual innervation of the gracilis is safe; and in some cases, does appear to provide early onset gracilis activation as well as an eventual spontaneous smile. |
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